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2100 Webster Street, Suite 214 San Francisco, CA 94115 (415) 923-3007 (415) 923-6586 (FAX)
LASIK Laser Eye Surgery San Francisco
LASIK Laser Eye Surgery San Francisco
NEW MULTIFOCAL LENS IMPLANTS
Rezoom - Restor Lens
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Before Your Visit


Download Patient Registration Form

Download History Form

Download Patient PHI Disclosure Form

Download Refraction Handout

Download Records Release Form

Download Request For Consultation Form

Download Notice of Privacy Practices

 

Also bring along your insurance card, glasses and a list of your current medications. The following may be helpful to you:


1. When your insurance policy requires an authorization from a Primary Care Physician, you must bring it with you at the time of your visit. If your plan includes glasses and contact lenses, contact your human resources office or insurance company for allowable amounts. You may need to obtain a "Vision Claim Form" to bring to your appointment. Without the appropriate forms, payment in full will be required at the time of service.

2. If we are contracted with your insurance company, any required co-payment will be collected at the time of service and the remaining amount billed for you. Please check with your insurance company's member services department to ensure that the physician you are seeing is contracted with your plan.

3. If we are not contracted with your insurance company or you have not met your deductible, payment is due upon your visit.

4. Most health plans, including Medicare, do not cover eyeglass prescriptions (refraction). Due to complicated Medicare rules, we are required to make a separate charge for this service. Our fee is $75 and is due at the time of service. There are a few health plans however, that do cover this service. You should verify with your plan to see if you have any coverage for refractions or for eyeglasses or contact lenses.

If you have any billing questions or need to set up financial arrangements prior to being seen, or would like information about financing your procedure, our Patient Financial Services Office is ready to assist you at (415) 923-3485, or e-mail us at eyeservices@pacificeye.com

We look forward to serving all of your eye care needs!